Archived: Greenroyd Residential Home

Greenroyd Residential Home is a care home in Hest Bank. It is registered to care for up to twenty-three people living with dementia assessed as needing residential care. The home has three floors. There are three lounges and two dining rooms on the ground floor. Access to upper floors is by way of a passenger lift and stair lift to the first floor. All bedrooms are for single occupancy and have en-suite facilities. At the time of the inspection visit sixteen people were receiving care and support at the home.

Greenroyd Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenroyd Residential Home was inspected in March 2017and was rated as inadequate. We re-inspected the service in September 2017 to check what improvements had been made and found some but not all improvements had been made. At the inspection visit in September 2017 the registered provider continued to fail to meet all the fundamental standards. Breaches were identified of the Health and Social Care Act (2008) Regulated Activities 2014. These related to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, premises and equipment, good governance and staffing. The service therefore remained rated as inadequate and in special measures.

We used this inspection visit carried out in February 2018 to check to see if the required improvements had been made.

During this inspection in February 2018, we found some but not all improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported at the home by a manager. The manager had responsibilities for the day to day running of the home.

Following the inspection visit carried out in September 2017, the registered provider had worked to improve systems and processes to ensure the fundamental standards were achieved. Although we found improvements had been made, during this inspection visit we identified a breach to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure medicines administration was in line with current guidance. Systems were not in place for ensuring medicines were appropriately and safely administered.

The manager had developed a training plan and had identified external trainers to provide training to staff. However, training had not yet been fully provided to staff to enable them to have all the required skills to complete their role appropriately. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as staff had not been provided with the appropriate skills to carry out their role.

The registered provider had started to make improvements to make the home more dementia friendly but work had not been completed at the time of the inspection. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the premises were not suitably maintained for people who were living with dementia.

Some improvements had been made to improve the quality of paperwork and documentation at the home. Although some improvements had been made we found paperwork was not always accurate and complete. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The manager had reviewed the auditing systems at the home and made improvements to the auditing system. Although some improvements had been made, we found the audits had not been firmly embedded to ensure all concerns were identified. In addition, we found systems to ensure good governance at the home were not always complete. Advice and guidance provided at the last inspection visit and by other professionals had not been acted upon. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as systems to ensure good governance were not established.

Staffing levels had been reviewed and work had begun to review the staff dependency calculator. We saw staff were not rushed and had time to meet people’s needs in a timely manner. Oversight within lounges had improved to promote the safety of people who lived at the home. We have made a recommendation about deployment of staffing.

We looked at how people’s dietary needs were being met by the registered provider. Improvements had been made to ensure staff were suitably deployed at meal times. People were offered choices of meals. We have made a recommendation in regards to providing suitably nutritious meals which promote health and well-being at all times.

Relatives we spoke with told us they had no complaints about the service provided. They said the manager was approachable.

We reviewed how information was provided to people who lived at the home. We found information was not always accessible. We have made a recommendation about this.

At this inspection visit carried out in February 2018, the manager had reviewed safeguarding processes to promote peoples safety and well-being. New systems had been introduced to reduce the risk of people being harmed from abuse.

Systems had been reviewed to ensure risk was suitably managed and risk was lessened. This meant falls risks and risk associated with the usage of bed rails were suitably managed.

The manager had reviewed systems to ensure person centred care was delivered and achieved. This included reviewing people’s care records to ensure they clearly documented people’s needs and preferences. We observed person centred care being delivered throughout the inspection visits. Improvements had been made to ensure required documentation was completed in a timely manner when care and treatment had been delivered.

Improvements had been made to promote infection control processes at the home. The manager had taken on the role of infection prevention champion and had reviewed systems and processes to make sure they were in line with good practice.

People who lived at the home and relatives praised the caring and helpful nature of staff. From observations we saw staff were patient and respectful with people. People’s needs were met in a timely manner.

The manager had reviewed activities for people who lived at the home to ensure activities provided were appropriate for people living with dementia. We observed activities taking place. People responded positively to activities being offered.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Feedback from staff who worked at the home was positive. We observed staff carrying out their duties responsibly and in a caring manner.

End of life care had been discussed with some people and their relatives. Provisions were in place to promote a dignified and pain free death.

Feedback was routinely sought from relatives. We saw relatives had been consulted with through relatives meetings and through formal questionnaires.

This is the first time the service has been rated Requires Improvement. Although this service had improved since the last inspection we still need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

You can see what action we have taken at the back of the full report.

Greenroyd Residential Home is a detached property situated in Hest Bank, close to Morecambe and Lancaster. The home is registered for up to twenty three people living with dementia and has three floors, a lift and stair lift. There are three lounges and two dining rooms on the ground floor. All rooms are single and have en suite facilities. At the time of the inspection visit twenty people were receiving care and support at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 09, 16, and 22 March 2017 and was rated as Inadequate. We identified breaches to Regulation 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and a breach to CQQ Registration Regulations 2009. Following this inspection visit the service was placed in special measures.

At this inspection visit carried out between August and September 2017, we found the management team had worked hard to make improvements however further work is required to ensure the fundamental standards are understood and embedded within the service. Breaches were identified to Regulations, 9, 10, 12, 13, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Deployment of staffing was poor. Measures put in place to review staffing levels and staff deployment were ineffective. Training for staff was out of date and incomplete.

Whilst some improvements had been made to manage risk we found not all risks had been considered. Care records did not consistently identify risk and ways to reduce risk. Good practice guidelines were not always considered and implemented.

Infection control processes were inconsistent and did not always follow regulatory guidance. During the first day of the inspection visit we found areas of the home which were not to a required standard and conflicted with information held within the infection prevention and control audit.

Whilst improvements had been made in relation to the recording of falls we found records continued to be inaccurate and up to date. Care plans and documentation did not always identify people’s risk and did not always reflect people’s health needs. Care records were not consistently updated when people’s care needs had changed.

The registered provider had formalised an auditing system to ensure people who lived at the home were provided with safe and effective care. Whilst improvements had been made to the auditing of falls we found other auditing systems were ineffective and had failed to identify the concerns we noted during our inspection visit.

Whilst improvements were noted in the way safeguarding concerns were reported and responded to, we continued to find people were not always protected from the risk of abuse and harm. Processes in place for managing safeguarding incidents were not always clear and comprehensive.

We noted a lack of disparity between service policies and staff practice. Staff roles and responsibilities were unclear.

Visions and values at the home were not person centred. Dignity and respect were not consistently addressed and considered by staff.

Improvements had been made to mitigate risk within the environment. However, we found recommendations had not been acted upon to ensure premises were inclusive for people living with dementia. We found equipment required to meet people’s needs was not always provided and fully functional at the home.

Organised activities did not always take into consideration people’s individual needs and abilities. We have made a recommendation about this.

Relatives said the food provided at the home was satisfactory. Deployment of staffing at meal times was variable and had a bearing upon the meal time experience for people.

We looked at how medicines were managed by the service. Good practice guidelines were not always consistently followed. We have made a recommendation about this.

The registered provider had a system for managing complaints. Relatives told us they had previously raised concerns with the registered manager. These however had not been formally documented by the registered manager. We have made a recommendation about this.

We received mixed feedback about the caring nature of staff. Observations made during the inspection process showed that staff interactions were variable. Staffing levels and staff deployment meant there was a focus on completing tasks as opposed to spending quality time with people.

Recruitment procedures were implemented by the registered provider which meant staff were correctly checked before starting employment.

The registered provider was aware of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. (DoLS.) We saw evidence of processes being followed to ensure people were only deprived of their liberty lawfully.

Relatives of people who lived at the home told us they were consulted with and involved in the management of the home. They told us they were able to make suggestions as to how improvements could be made. We saw evidence of this occurring.

Staff were positive about ways in which the service was managed and the support received from the management team. They described a positive working environment.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

Greenroyd is a large detached property situated in a rural location close to Morecambe and Lancaster. The home is registered to for up to twenty three people living with dementia. The home has three floors. There are three lounges and two dining rooms on the ground floor. There is a lift and stair lift for people with limited mobility. All rooms are single and have en suite facilities. Private car parking facilities are available.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected 05 November 2014. At this inspection we found the service was meeting all the fundamental standards and was rated as, ‘Good.’

At this inspection visit carried out in March 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards.

We looked at how the service managed risk to keep people safe. We found risk was not appropriately addressed and managed. We found not all risks were identified. When risk assessments were present they were not consistently followed. We also found when risks were evident; these were not always addressed proactively. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, when people had unexplained injuries these were not reported to the local authority safeguarding team and the Care Quality Commission (CQC) for review. We identified a high number of safeguarding concerns that had not been reported to management or external bodies. This meant systems to ensure people were safe from abuse were not consistently followed. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service users from abuse and improper treatment).

We looked at records maintained by the service. We noted records were not always accurate and up to date. We found accident reports did not always reflect the injuries people sustained. Entries within care records contained inaccurate information and body maps which were used to highlight people’s injuries were not accurate and up to date. Care records were not consistently updated when people’s care needs had changed. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

During the inspection visit we reviewed the auditing systems established and operated by the registered provider. We found that auditing systems in place were ineffective and failed to identify the concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

Deployment of staffing did not meet the needs of the people who lived at the home. We observed people sat and waited for over an hour before their meals were served. We observed one staff member supporting two people to eat a meal at the same time. During the inspection process we found 234 incidents had been reported by staff on accident forms over a fourteen month period. Of these incidents, 177 were not witnessed by a staff member and 74 occurred during the night time. There were only two staff on duty during the night and there was no evidence to show that staffing levels had been considered and reviewed following the number of falls. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing).

During the inspection visit we identified nine safeguarding incidents that should have been reported to the CQC. We found 15 serious injuries had occurred at the home but these had not been reported to the CQC as required. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).

We found care documentation was not consistently person centred. Care plans were task focussed and did not consider providing support in an individualised way. Relatives we spoke with told us that person centred care was not always carried out. We have made a recommendation about this.

People who lived at the home and relatives said the food provided at the home was good. They told us there was plenty of choice and their nutritional and health needs were met. Systems were in place for managing people’s dietary needs. We noted input from health specialists when people were at risk of malnutrition.

We looked at how medicines were managed by the service. We found good practice guidelines were followed to ensure people received their medicines safely and accurately.

People and relatives said staff were caring. We observed some caring interactions during the inspection process, however noted some interactions where dignity and person centred care was not delivered. We have made a recommendation about this.

We received mixed feedback about the provision of recreational activities at the home. Six of the seven relatives told us they were happy with activities provided. On the days of the inspection visits we observed activities taking place at the home. Staff told us they sometimes changed activities to meet people’s needs.

Staff had a sound understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. Mental capacity was routinely assessed and good practice guidelines were referred to when a person lacked capacity. We saw evidence of robust processes being followed to ensure people were only deprived of their liberty lawfully.

Staff praised the variety of training on offer and said they felt supported within their role. They told us they could make requests for training when they felt they required additional support and guidance and action was always taken to meet their training needs.

Suitable recruitment procedures were implemented which meant staff were correctly checked before starting employment.

Systems were in place to seek feedback from people who lived at the home, staff and relatives as a means to develop and improve service delivery. We noted there was a low response rate and discussed the reasons as to why this might be with the registered manager.

We received mixed feedback about the responsiveness of the management team to making improvements. Two relatives said they had made suggestions for improvement but no action had been taken. We discussed this with the registered manager at feedback.

The registered provider had a system for managing complaints. Relatives told us they were confident they could raise complaints and concerns and felt they would be listened to. Relatives said the management team was approachable and they were confident if they had any concerns action would be taken.

Staff were positive about ways in which the service was managed and the support received from the management team. They described a positive working environment.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

Due to the dementia condition of residents, some people had limited verbal communication and understanding and were unable to hold a conversation with us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff.

During the inspection we looked at care, medication, recruitment and staff training records. We also talked to with residents about the home and the standard of food they received.

Staff members we spoke with had an awareness of peoples care needs. We discussed with staff individual needs of residents. Comments included, 'Although most have difficulty understanding conversation due to their level of dementia, we know when someone has a problem or doesn't feel well.'

We spoke individually to three residents living at Greenroyd. They told us they were happy living at the home and they liked the staff team and felt cared for. One resident said, 'Yes they are all lovely. We also have good cooks.'

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the home.

This home cares for people with a range of dementia conditions and conversation with most residents was limited due to their dementia condition. We therefore spent much of the time in the communal areas making observations of how people were being cared for.

Residents we did speak to had positive comments about their life at Greenroyd and included, 'The food and staff are excellent.' Also, 'I cannot fault anything about this home, the people are wonderful and everyone treats you well.'

Family members we spoke with about the care and support given to their relatives were positive and included, 'They always keep us informed about mums care.' Also, 'Today we are going through mums care plan review. The staff and manager are the best.'

When asked about routines and activities in the home people we spoke with told us it was relaxed and always something going on, Comments from staff included, 'Trips out, entertainment, games and events are always going on at the home.' A relative said, 'They went around Blackpool lights last week.'